摘要目的 探讨根治性前列腺切除术(RP)后2014版国际泌尿病理协会(ISUP)病理分级较前列腺穿刺活检病理分级升高的预测因素.方法 回顾性分析2017年1月至2018年12月中山大学肿瘤防治中心收治的205例前列腺癌患者的临床病理资料.中位年龄66(45～81)岁.中位PSA 17.16(0.89～1 254.00) ng/ml.中位前列腺体积36.4(4.1 ～152.1)ml.患者均行前列腺穿刺活检,中位穿刺针数10(1～15)针;中位穿刺Gleason评分7(6 ～10)分;中位穿刺病理ISUP分级3(1～5)级,其中1级49例(23.9％)、2级52例(25.3％)、3级20例(9.8％)、4级47例(22.9％)、5级37例(18.0％).患者均行RP治疗.根据RP术后病理ISUP分级是否升高分为2组,采用logistic多因素回归分析病理ISUP分级升级的预测因素,应用受试者工作特征曲线(ROC)确定预测RP术后病理ISUP分级升级的穿刺病理ISUP分级截断值.结果 本研究205例RP术后中位Gleason评分7(6～10)分,中位病理ISUP分级3(1 ～5)级,其中1级24例(11.7％)、2级51例(24.9％)、3级56例(27.3％)、4级20例(9.8％)、5级54例(26.3％).与穿刺病理ISUP分级比较,205例中RP术后病理ISUP分级升高73例(35.6％)、一致91例(44.4％)、降低41例(20.O％).穿刺病理ISUP分级是RP术后ISUP分级升高的独立预测因子(OR=0.496,P＜0.001).穿刺病理ISUP分级预测RP术后病理ISUP分级升高的ROC曲线下面积为0.746(95％ CI0.680 ～0.812).当穿刺病理ISUP分级≤2级时,RP术后发生ISUP分级升高的可能性较大,敏感性为75.3％,特异性为65.2％.101例穿刺病理ISUP分级≤2级患者中58例(57.4％) RP病理ISUP分级升高;67例穿刺病理ISUP分级为3～4级患者中仅18例(26.9％)RP病理ISUP分级升高.结论 穿刺病理ISUP分级≤2级的前列腺癌患者RP术后出现ISUP分级升高的可能性较大.

abstractsObjective To investigate the risk factors predicting pathology grade upgrading after radical prostatectomy using the 2014 International Society of Urologic Pathology (ISUP) grading system.Methods A total of 205 patients who underwent biopsy and radical prostatectomy from January 2017 to December 2018 were reviewed retrospectively.The median and range of the patients' age,PSA level,prostate volume,number of biopsy core examined,Gleason score and ISUP grade were 66 (45-81) years old,17.16(0.89-1254.00)ng/ml,36.4(4.1-152.1) rnl,10(1-15),7(6-10),and 3(1-5) respectively.The patients were divided into group of upgrading ISUP grade and group without upgrading ISUP grade.Multivariate Logistic regression analysis and receiving operating characteristic curve analysis were performed to identify predictors of ISUP upgrading and determine the optimal cut off value respectively.Result The median and range of Gleason score and ISUP grade after radical prostatectomy were 7 (6-10),and 3 (1-5) respectively.The radical prostatectomy ISUP grade upgraded in 73 (35.6％) out of 205 cases when compared with biopsy ISUP grade.Radical prostatectomy ISUP grades were concordant in 91 cases (44.4％) and downgraded in 41 cases(20.0％).Of 101 with biopsy ISUP grades less than or equal to 2,the ISUP grade of radical prostatectomy upgraded in 58 cases (57.4％),while radical prostatectomy ISUP grade upgraded in only 18 (26.9％) of 67 patients with biopsy ISUP grades of 3 or 4.Biopsy ISUP grades represent an independent predictor for ISUP grade upgrading after radical prostatectomy (OR =0.496,P ＜ 0.001).Conclusion Patients with biopsy ISUP grades less than or equal to 2 are at great risk of ISUP grade upgrading after radical prostatectomy.